Difficulties in assessing depressive-like reactions to chronic severe external stress as exemplified by spouse caregivers of Alzheimer patients

Problems in making differential diagnoses and severity ratings of depressive-like reactions in chronically, heavily stressed persons are described. These assessment concerns are especially pertinent to older persons. The assessment concern discussed relates to difficulties in determining the extent to which stress reactions are inevitable consequences of stressor demands versus excessive pathological reactions versus natural manifestations of aging. The newly revised criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III-R) and its associated structured interviews do not lessen the difficulties described. However, they reflect progress in specifying the amount of cross-sectional and longitudinal consistency required before maladaptive behaviours meet diagnostic and/or severity criteria as pathological indicators. Stressor level is important among the criteria for the less severe DSM-III-R depression-related disorders, but the specific response demands of the stressors are ignored. By contrast, biomedical factors are consistently given significant weight. To clarify these matters, the five DSM-III-R diagnostic axes, depressive diagnostic criteria, and associated structured interviews for eliciting relevant data are reviewed.     

Object relations in borderlines, depressives, and normals: an examination of human responses on the Rorschach

Recently, researchers and clinicians have become increasingly interested in diagnostic distinctions between borderline and mood disorders. Object relations theory provides a useful framework for the comparison of these two overlapping diagnostic categories. In our study, a measure of object relations as represented on the Rorschach, developed by Blatt, Brenneis, Schimeck, and Glick (1976), was applied to data produced by borderline and depressive inpatients and by normal comparison subjects. Portions of the Blatt measure that tap the subject's experience of human action and interaction distinguish among the three diagnostic groups. Specifically, borderlines tend to understand human action as more highly motivated and human interaction as more malevolent in nature than do either depressive or normals. The data indicate that borderlines experience the object-relational world in a way that is fundamentally different from the way normals and depressives perceive it. Implications are discussed for theories of borderline object relations.     

The meaning and suitability of various effect sizes for structured Rater x Ratee designs

Four types of analysis are commonly applied to data from structured Rater x Ratee designs. These types are characterized by the unit of analysis, which is either raters or ratees, and by the design used, which is either between-units or within-unit design. The 4 types of analysis are quite different, and therefore they give rise to effect sizes that differ in their substantive interpretations. In most cases, effect sizes based on between-ratee analysis have the least ambiguous meaning and will best serve the aims of meta-analysts and primary researchers. Effect sizes that arise from within-unit designs confound the strength of an effect with its homogeneity. Nonetheless, the authors identify how a range of effect-size types such as these serve the aims of meta-analysis appropriately.     

Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies

A meta-analysis examined data from 36 studies linking physical activity to well-being in older adults without clinical disorders. The weighted mean-change effect size for treatment groups (d(C). = 0.24) was almost 3 times the mean for control groups (d(C). = 0.09). Aerobic training was most beneficial (d(C). = 0.29), and moderate intensity activity was the most beneficial activity level (d(C). = 0.34). Longer exercise duration was less beneficial for several types of well-being, though findings are inconclusive. Physical activity had the strongest effects on self-efficacy (d(C).= 0.38), and improvements in cardiovascular status, strength, and functional capacity were linked to well-being improvement overall. Social-cognitive theory is used to explain the effect of physical activity on well-being.     

The effect of a contraceptive theme on response to erotica

Undergraduate students (60 males, 60 females) viewed a sexually explicit movie in which a couple engaged in intercourse. Different themes were introduced by prefacing the film with information varying the filmed couple's apparent marital status (single, married) and contraceptive practices (no information, no contraception, contraception via the pill). After viewing the movie, subjects filled out a questionnaire assessing their own affective reactions plus their perceptions and evaluations of the couple. Male subjects reported the greatest positive affect when the film couple was described as single and using contraception, but they also perceived the stimulus couple as caring the least for one another when they were using contraceptives. In contrast, females perceived contraceptive use as positive evidence of mutual caring. These sex differences in reacting to contraceptive use were discussed in terms of the relatively greater tendency of males to separate love and sex than is true for females.Work on this experiment was supported by a research grant (SOC 74-15254) from the National Science Foundation. The authors wish to thank Elizabeth Rice Allgeier, William A. Fisher, and Richard Knox for their comments and suggestions.     

Facet measures and global job satisfaction

This research was an attempt to find evidence for Scarpello and Campbell's (1983) conclusion that a single-item global measure is more content valid than a composite facet measure for assessing overall job satisfaction. The first study investigated responses from employees in three separate plants who completed a facet measure, a single-item global measure, along with items and facets chosen by an employee committee. Results indicated that the employee-chosen facets accounted for some incremental variance in the prediction of the single-item measure. A second study investigated the relationship between a single-item and a facet measure of benefit package satisfaction when the entire benefit package domain was included in the facet measure. The magnitude of the relationship suggested that the single-item measure of global benefit package satisfaction involved consideration of more than merely satisfaction with each element in the package. Limitations and alternative explanations for the findings are discussed.The helpful comments of Mark E. Tubbs and John W. Jones on an earlier version of this article are greatly appreciated.